A large cervical osteophyte presenting as an oropharyngeal mass.
Clinically, the patient was not septic. Intraoral examination revealed a hard, 3-cm mass with normal mucosa originating from the right posterolateral oropharyngeal wall behind the right tonsillar fossa (figure 1). There was no associated cervical lymphadenopathy. Endoscopic evaluation showed that the rest of the upper aerodigestive tract was normal.
Computed tomography (CT) of the oropharynx and neck with contrast was performed to rule out malignancy. The scan revealed a marked degenerative cervical spine with large oesteophytes of C 1 and C2 protruding into the right oropharynx (figure 2). The overlying mucosa remained intact. In view of the patient's mild symptoms, she agreed to conservative management with a soft diet. Upon follow-up, her symptoms were found to have resolved after dietary modification.
An oropharyngeal mass in an elderly patient requires assessment by an otolaryngologist because of the possibility of malignancy, which usually presents with mucosal ulceration, bleeding, and associated cervical lymphadenopathy. The oropharynx is rich with lymphoid tissue, and lymphoma is an alternative neoplastic condition that presents in the same fashion as an epithelial malignancy, such as squamous cell cardnoma. Both can be diagnosed with transoral biopsy of the lesion.
[FIGURE 1 OMITTED]
A parapharyngeal-space tumor also presents as an oropharyngeal bulging with intact overlying mucosa when it grows to a significant volume. Other benign conditions in the differential diagnosis include retropharyngeal abscess, which should be considered in a septic patient, and an ectopic internal carotid artery, which is rare and manifests as a pulsatile protrusion of the oropharyngeal wall)
Bony outgrowths from cervical vertebrae are commonly seen in the elderly, and they are usually asymptomatic. These may be osteophytes arising from cervical spondylosis, or they may be due to primary musculo-skeletal disorders, such as diffuse idiopathic skeletal hyperostosis (DISH). (2) Bony outgrowths may also arise less frequently after neck trauma or cervical spine surgery. (3)
When cervical osteophytes increase in size, they lead to external impingement on or mucosal irritation of the pharynx and esophagus. This contributes to globus pharyngeus, dysphagia, and even aspiration. (2,3) When a large osteophyte arises from the upper cervical vertebrae, as in our case, where it occurred at the C1 to C2 articular margins, it presents as a large oropharyngeal mass. (4)
[FIGURE 2 OMITTED]
Osteophyte-induced dysphagia can be managed initially with diet modification and nonsteroidal anti-inflammatory drugs. Surgical intervention is indicated in severe cases in which conservative treatment has failed.
(1.) Prokopakis EP, Bourolias CA, Bizaki AJ, et al. Ectopic internal carotid artery presenting as an oropharyngeal mass. Head Face Med 2008;4:20.
(2.) Ozgocmen S, Kiris A, Kocakoc E, Ardicoglu O. Osteophyte-induced dysphagia: Report of three cases. Joint Bone Spine 2002;69(2): 226-9.
(3.) Ortega-Martinez M, Cabezudo JM, Gomez-Perals LF, Fernandez-Portales I. Anterior cervical osteophyte causing dysphagia as a complication of laminectomy. Br J Neurosurg 2005; 19(2): 174-8.
(4.) Little M, Akhtar S. Oropharyngeal mass diagnosed as a large cervical osteophyte. Br J Oral Maxillofac Surg 2009;47(1):82-3.
Joseph Chun-Kit Chung, MRCS; Wai-Kuen, Ho
From the Division of Otorhinolaryngology, Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR, China
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||HEAD AND NECK CLINIC|
|Author:||Chung, Joseph Chun-Kit; Ho, Wai-Kuen|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Case study|
|Date:||Oct 1, 2011|
|Previous Article:||Endoscopic views of ostia of the anterior wall of the ethmoid bulla.|
|Next Article:||Osteosarcoma of the skull base in a 15-year-old boy.|